Healthcare costs are increasing and, as a result, payers, such as government agencies and insurance companies, are seeking to reduce costs. Government agencies, such as Medicaid and Medicare, are experiencing large increases in expenditures. Insurance companies are also experiencing cost pressures and are increasing policy rates.
In many cases, payers have implemented rules and conditions under which they will pay for a procedure or examination. In addition, these payers have developed disease management programs to manage disease treatment and prevent or mitigate expensive consequences to manageable diseases, such emergency room visits and hospitalization.
However, insurance companies, government agencies, and other organizations associated with health services have difficulty communicating with physicians. Physicians generally have greater access to the patient. When physicians lack information about a payers rule or a specific patients disease management program, they may not conform to the rules or guide the patient's compliance with the disease management program. As such, an improved system for providing input of disease management algorithms to disease management systems and integrating the algorithms into physician workflow would be desirable.
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